人类嗜T淋巴细胞病毒I型相关脊髓病患者中干燥综合征的高患病率。

High prevalence of Sjögren's syndrome in patients with HTLV-I associated myelopathy.

作者信息

Nakamura H, Eguchi K, Nakamura T, Mizokami A, Shirabe S, Kawakami A, Matsuoka N, Migita K, Kawabe Y, Nagataki S

机构信息

First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.

出版信息

Ann Rheum Dis. 1997 Mar;56(3):167-72. doi: 10.1136/ard.56.3.167.

DOI:10.1136/ard.56.3.167

PMID:9135218

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1752335/

Abstract

OBJECTIVE

A high seroprevalence of HTLV-I in female Sjögren's syndrome (SS) patients has been reported in Nagasaki, Japan, an area that is heavily endemic for HTLV-I infection. Salivary IgA class antibodies to HTLV-I were common among HTLV-I seropositive patients with SS. This study was undertaken to elucidate the pathogenesis of SS caused by HTLV-I infection.

METHODS

The clinical features and histological findings of SS and the prevalence of serum autoantibodies in 10 patients with HTLV-I associated myelopathy (HAM) who were consecutively admitted into Nagasaki University School of Medicine, were compared with those of 20 HTLV-I seropositive and 20 HTLV-I seronegative patients with SS.

RESULTS

Ocular and oral manifestations of SS were commonly detected in HAM patients. These patients also had extraglandular manifestations including recurrent uveitis, arthropathy, interstitial pneumonitis, Raynaud's phenomenon, and inflammatory bowel disease. All patients with HAM histologically showed a mononuclear cell infiltration in the labial salivary glands. Six of 10 patients had a mononuclear cell infiltration with a focus score of 1 or greater. According to the preliminary criteria for SS proposed by the European Community, definitive SS was diagnosed in six patients and probable SS in two patients. Serum gamma globulin and IgG values were increased in HAM patients. Patients with HAM had lower prevalence of rheumatoid factor, antinuclear antibody, and anti-SS-A (Ro) antibody than those of HTLV-I seropositive and HTLV-I seronegative SS patients. However, there was no significant difference in the prevalence of these antibodies among HAM patients with definitive SS, HTLV-I seropositive and HTLV-I seronegative SS patients. The CD3+CD4+ T cells preferentially infiltrated into the salivary glands in HAM patients as well as the salivary glands of patients with HTLV-I seropositive and seronegative patients. It seems probable that peripheral blood mononuclear cells from HAM patients preferentially infiltrated into the salivary glands, and that these cells produced the autoantibodies as well as anti-HTLV-I antibody.

CONCLUSION

The results strongly support the idea that HTLV-I is involved in the pathogenesis of the disease in a subset of patients with SS in endemic areas.

摘要

目的

在日本长崎，一个HTLV-I感染高度流行的地区，有报道称女性干燥综合征（SS）患者中HTLV-I血清阳性率很高。HTLV-I血清阳性的SS患者中，唾液中IgA类抗HTLV-I抗体很常见。本研究旨在阐明HTLV-I感染所致SS的发病机制。

方法

将长崎大学医学院连续收治的10例HTLV-I相关脊髓病（HAM）患者的SS临床特征、组织学表现及血清自身抗体患病率，与20例HTLV-I血清阳性和20例HTLV-I血清阴性的SS患者进行比较。

结果

HAM患者中常见SS的眼部和口腔表现。这些患者还存在腺体外表现，包括复发性葡萄膜炎、关节病、间质性肺炎、雷诺现象和炎症性肠病。所有HAM患者组织学上均显示唇腺有单核细胞浸润。10例患者中有6例单核细胞浸润且灶性评分≥1。根据欧洲共同体提出的SS初步标准，6例患者诊断为确诊SS，2例患者诊断为可能SS。HAM患者血清γ球蛋白和IgG值升高。HAM患者类风湿因子、抗核抗体和抗SS-A（Ro）抗体的患病率低于HTLV-I血清阳性和HTLV-I血清阴性的SS患者。然而，确诊SS的HAM患者、HTLV-I血清阳性和HTLV-I血清阴性的SS患者之间这些抗体的患病率无显著差异。CD3+CD4+T细胞优先浸润到HAM患者的唾液腺以及HTLV-I血清阳性和血清阴性患者的唾液腺中。HAM患者的外周血单个核细胞似乎优先浸润到唾液腺中，并且这些细胞产生自身抗体以及抗HTLV-I抗体。